Provider Demographics
NPI:1447439013
Name:STEVEN P CONSOER
Entity type:Organization
Organization Name:STEVEN P CONSOER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MGR
Authorized Official - Prefix:
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:OSSMO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-884-8338
Mailing Address - Street 1:7872 MARKET BLVD
Mailing Address - Street 2:
Mailing Address - City:CHANHASSEN
Mailing Address - State:MN
Mailing Address - Zip Code:55317-9440
Mailing Address - Country:US
Mailing Address - Phone:952-934-1424
Mailing Address - Fax:952-934-2140
Practice Address - Street 1:7872 MARKET BLVD
Practice Address - Street 2:
Practice Address - City:CHANHASSEN
Practice Address - State:MN
Practice Address - Zip Code:55317-9440
Practice Address - Country:US
Practice Address - Phone:952-934-1424
Practice Address - Fax:952-934-2140
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STEVEN P CONSOER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-10-30
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN0645310002Medicare NSC